The NICE organisation has suggested minimum standards for manning and A&E Department. Basically one or two nurses per 4 cubicles are recommended. Is setting minimum manpower standards the way of resolving the problems for patients getting appointments in general practice?
Since 2004 the numbers game seems to have been dropped in general practice. Going back in time to the 60’s I recall that a full time GP worked 9 sessions per week spread over 5 days per week. Few doctors worked part time. There were no trainee GPs to help and few salaried assistants. There were also controls on admission to the ‘Medical List. A practice with an average list per WTE doctor that exceeded 2,500 was considered under-doctored whilst a practice with an average list below 1,800 was considered over-manned. Statistical sources now suggest that the average GP list is now below 1,800. So what went wrong?
I wonder if the original rules for classifying practice areas were reapplied now taking into account the actual sessions GPs now work, making allowances for trainee GPs and nurse practitioners whether the picture would show where location wise the problems really are? Practices are now allowed to use their budgets to fix their own manning levels but does this mean that there is a fair distribution of manpower? You may remember that Dr John Oldham promoted the idea of Advanced Access and under his system of seeing patinets today or tomorrow the idea was that manpower could be adjusted to meet demand. The problem with such a system of asking GPs in a practice to work different or extra sessions is that not all GPs would want to do it. There are doctors with outside committments such as the local Commissioning Group. There are doctors who work part time for family reasons. There are doctors working as trainers. Oh, there is also the premise to provide patients with 10 minutes appointments. Another system recently promoted is the idea of ‘speaking to the Doctor First. In fact telephone consultations have become more popular but in my view are not the total answer. Finally there is the restriction on the GPs working day of 8:00 to 18:30. Extended hours has only had the efect of time shifting – it is not extra time. So again in my view time in general practice is not that flexible so it comes back to increasing manpwer.
Perhaps we need a new set of rules that lay down the ídeal’ manpower levels for a medical practice. Might it be for instance, one whole time GP per 1,200 patients.What do you think?